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modifier fifty

  1. Default modifier fifty
    Medical Coding Books
    Can you append modifer 50 to CPT 73030

  2. #2
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    North Carolina
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    3,126
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    Yes...It has a status indicator of 3

  3. #3
    Location
    Capital Coders, Columbia, SC
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    145
    Default
    Modifier 50 is used to report bilateral procedures. Most carriers will not accept modifier 50 with radiology services. For bilateral radiology services, you should report separately with modifiers LT and RT.

    Bill Hale, CPC

  4. #4
    Location
    grand canyon(PHX)
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    24
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    I was just going say just that. It is payer specific some like 50 some like billing it twice one with a RT and the other with a LT. An obviously it is critical that there be documentation for medical necessity
    Robert A Kiesecker CPC CCC CPC-I

  5. #5
    Location
    North Carolina
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    Bill,

    Give me your opinion on this........

    http://www.medicarenhic.com/provider...vices_1106.pdf


    Modifier 50, is used to report diagnostic, radiology and surgical procedures. Modifier 50 applies to any bilateral procedure performed on both sides at the same session. Do not use Modifiers RT and LT when modifier 50 applies. A bilateral procedure is reported on one line using modifier 50. The quantity entry to use when modifier -50 is reported is one.

    Also...CMS states....

    3=The usual payment adjustment for bilateral procedures does not apply. If the procedure is reported with modifier -50 or is reported for both sides on the same day by any other means (e.g., with RT and LT modifiers or with a 2 in the units field), base the payment for each side or organ or site of a paired organ on the lower of (a) the actual charge or each side or (b) 100% of the schedule amount for each side.

  6. #6
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    North Carolina
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    http://www.cms.hhs.gov/manuals/downloads/clm104C23.pdf

    Modifier 50 is addressed on page 140 and status indicator 3 is addressed on page 141...

    3 = The usual payment adjustment for bilateral procedures does not apply. If procedure is reported with modifier -50 or is reported for both sides on the same day by any other means (e.g., with RT and LT modifiers or with a 2 in the units field), base payment for each side or organ or site of a paired organ on the lower of: (a) the actual charge for each side or (b) 100% of the fee schedule amount for each side. If procedure is reported as a bilateral procedure and with other procedure codes on the same day, determine the fee schedule amount for a bilateral procedure before applying any applicable multiple procedure rules.

    Services in this category are generally radiology procedures or other diagnostic tests which are not subject to the special payment rules for other bilateral procedures.

  7. #7
    Location
    Capital Coders, Columbia, SC
    Posts
    145
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    Rebecca, I don't disagree that by definition, modifier 50, with a status indicator of 3, applies to radiology charges. And I appreciate your research and attention to accuracy on the matter. But, in reality, many payers have their own inerpretation of this guideline. This is why one should first check with his/her payers to see which they prefer. If you deal with any of the same insurance companies as I do, then they will tell you that they cannot advise on what they will pay and what they won't. You'll just have to bill it and find out. That is what I have done. Modifier 50 on radiology charges does not get paid (as two charges). Reporting them separately with LT and RT does. Unfortunately, this is just one of those things in which there are two ways to do it, but the one which seems to be correct, by the book, doesn't work.

    Bill

  8. #8
    Location
    North Carolina
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    3,126
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    Although we're practically neighbors, this doesn't seem to be an issue in our region. Most of our carriers accept modifier 50. I have also seen those same carriers accept the LT/RT modifiers when submitted. The only carrier that will not, under any circumstances, accept LT/RT is our Medcaid contractor. Thanks for you input and have a Happy 4th!

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